In modern psychiatry, there is more than one type of bipolar disorder, and patients may be told that they are ‘somewhere on the bipolar spectrum.’
This can be confusing to hear; as a newly diagnosed patient, you may wonder, ‘so do I really have bipolar disorder or not?’
According to the current, dominant model, the bipolar spectrum runs from bipolar I at one end, to cyclothymia and ‘not otherwise specified’ at the other.
You may have heard that bipolar disorder (BD) affects only one in a hundred people, but this is untrue — or only a partial truth — according to the spectrum model.
One percent of adults are thought to have bipolar I, which is the classic expression of the illness — uncontrollable manias, potentially with psychotic symptoms, interspersed with depression. But a total five percent of the population is said to have some form of bipolar disorder.
It’s easy to assume that the spectrum runs from ‘most severe’ at the left-hand side, to ‘least severe’ on the right. Bipolar I still carries the greatest stigma, perhaps because it most conforms to age-old stereotypes of what bipolar illness is like. When we see someone who is high-functioning and successful, despite having a diagnosis of BD, we might assume that they ‘only have a mild form’ of it. But there are many high-functioning people with bipolar I, and equally, there are people with cyclothymia or so-called ‘bipolar lite’ whose illness causes severe distress and dysfunction. So it’s difficult to make generalizations about which ‘type’ of bipolar is the worst.
A diagnosis of bipolar spectrum disorder may be made if you meet any of the following descriptions:
- Bipolar I:
Quite simply, this diagnosis is made if you’ve ever had a manic episode. Even just once. The other bipolars involve milder highs, or hypomania, not full-blown mania at all. The symptoms of hypomania are similar to those of mania, but less intense, and the person experiencing hypomania may be more able to control their own actions. In bipolar I, the episodes of depression can range from mild to very severe.
- Bipolar II:
In this classification, the individual ‘only’ has hypomanias, as opposed to full-blown mania. During these episodes, they may do, think or say things that are out of character for them, but they are unlikely to become psychotic, and may still be able to function normally at work and in relationships. However, it would be over-simplistic to think of this as a milder, less destructive form of bipolar than bipolar I, because the depressed episodes are just as severe and long-lasting. If anything, a bipolar II person may be depressed for much more of the time, which may explain why, statistically, they are more likely to commit suicide than people with any other form of bipolar illness.
- Cyclothymia and bipolar ‘not otherwise specified’:
Together, these are said to make up a further three percent of the population, putting a total of five percent of adults on the bipolar spectrum. People in these classifications also find that their moods ‘cycle,’ but neither the highs nor the lows are as severe as in bipolar I or II.
There is still potential for significant problems, though. For instance, people with cyclothymia may rarely be totally symptom-free; their mood changes may be mild, but they are almost continual. This contrasts sharply with the experience of many people with bipolar I, who can have months or even years of good health in between episodes of depression or mania. The ‘milder’ forms of bipolar can still hinder a person’s ability to maintain relationships or a career or to achieve other goals, because of the unpredictability of their moods.
Some more facts about bipolar affective disorders:
- Episodes of depression or mania can last days, weeks or months. Some people with bipolar disorder go months or years between episodes, whereas others have ongoing symptoms. There is almost no ‘typical’ experience of bipolar disorder.
- None of the classifications described in this article are set in stone. And not every bipolar person fits neatly into a category, e.g. clearly bipolar I, or totally bipolar II.
- Not everyone with a diagnosis of bipolar disorder will have to take medication. Depending on the severity and frequency of their episodes, a person may only be prescribed ‘standard’ antidepressants such as Prozac, or they may have long periods of not needing any medication at all. The idea that all bipolar people must be on mood stabilizers for life is becoming outdated.
- People with bipolar disorder can respond well to talk therapies, and they can also learn strategies for self-managing their moods.
- Stressful life circumstances make a bipolar person much more likely to have an episode. By reducing the causes of stress, the individual may be able to maintain good health. Diet, exercise and sleep pattern also are key.
- Most people with bipolar disorder develop symptoms in early adulthood, with the late 20s being the most typical age of onset. There is no known permanent cure for the illness, but some people find their symptoms ‘settle down’ in later life, especially if they have developed good insight into their condition and know how to manage it.
- Bipolar disorder is difficult to diagnose, and many sufferers wait ten years or more for an explanation of their feelings and behavior. Do speak to your primary care physician, and consider asking for a referral to a psychiatrist if you feel that your moods fit the description of a bipolar disorder.